A case study of quality of medical service for stroke and coronary heart disease before and after an upgrade to a hierarchical system of emergency services-responsive hospitals
| Autor: | LEE,CHIEN-TA, 李建達 |
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| Rok vydání: | 2016 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 104 Cardiovascular diseases have long been among the ten major causes of death in Taiwan. To improve medical service quality and outcomes in patients with stroke or coronary heart disease, regional and above medical institutions have established treatment centers for stroke, coronary heart disease, and other cardiovascular diseases. Provider accountability for continuity of patient care is ensured through a hierarchical system of emergency services-responsive hospitals implemented in July 2009. However, whether or not the quality of medical care for stroke and coronary heart disease improved after this network of hospitals was implemented has seldom been considered. Therefore, in order to improve medical service processes and outcomes, a case study was conducted, using records of patients who received hospital emergency medical services between January 2012 and November 2015. The usage of health insurance was analyzed, the data were summarized, and relevant indices were evaluated. The study was carried out for 3 domains: structure, process, and outcome. Existing emergency medical service conditions and the care needs and standards applied in individual cases were analyzed. The evaluation considered the general medical care of stroke and coronary heart disease patients before and after implementation of this hierarchical system, and whether index variations changed or the government's objectives for the upgrade were fulfilled. Statistical analysis (Stata version 10.0) was performed to examine whether index ratios achieved certain goals. This study found that the upgrade to a hierarchical emergency care system significantly improved hospital care processes for stroke and coronary heart disease patients. The overall emergency hospitalization rate increased by approximately 3%, the treatment time for Grade 1 and Grade 2 triage cases reduced by about 15-25 min, the treatment efficiency for severe cases increased, and the proportion of emergency consultations over 30 min increased by approximately 5%. However, the proportion of hospitalized observation or holding cases of over 48 h increased by about 0.18%, suggesting the treatment efficiency for mild cases still needs improvement. On the other hand, the overall return-to-emergency rate decreased, no medical treatment errors occurred, and medical service quality achieved certain standards. In order to improve quality of care for patients with emergent and severe conditions, medical information technologies should be implemented. However, the intensive care capabilities in the included hospitals need further investigation. Keywords: hierarchical system, emergency services-responsive hospitals, medical service quality, cardiovascular diseases |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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